A Project of The Annenberg Public Policy Center

Extras: Endorsements, Rockwell, Abortion

Our latest edition of Extras features doctors going to court to stop a conservative group’s ad, googly eyes and Catholic abortion attacks.

Says Who?

A television ad from the conservative Rethink Reform, a recently created advocacy arm of the Employment Policies Institute, uses doctors’ opposition to the Senate health care bill to attack the proposed plan.  "Many doctors fear new government plans to change our health care system," the ad says. "They understand that under the proposed rules, there will be longer waiting times and rationing of care for seniors." The ad ends with a scrolling list of "doctors against the plan." We’ve debunked the "rationed care" myth many times before, but this ad is more notable for other groups that found fault with it: at least two of the medical associations listed at the end.

The American College of Surgeons and the American Society of Plastic Surgeons objected to the use of their names in the ad. Rethink Reform told MSNBC’s Rachel Maddow that it listed the groups, and others, because “they signed this letter opposing it and we used their name because they signed the letter.” On Dec. 1, a collection of surgeon groups did indeed send a letter to Sen. Harry Reid saying they "must oppose the legislation as currently written." But the letter also commended the bill, saying it "goes a long way towards realizing the goal of expanding health insurance coverage and takes important steps to improve quality and explore innovative systems for health care delivery."

Are the groups trying to have it both ways? Maybe, although the letter, unlike the ad, said nothing about longer waiting times or rationed care for seniors. And then there was the matter of the optics of being named in a third-party ad attacking the bill while still negotiating with Reid. The letter said that "the surgical coalition is committed to the passage of meaningful and comprehensive health care reform that is in the best interest of our patients. We are committed to working with you to make critical changes. …"

Both surgeons’ groups asked Rethink Reform to take their names off the ad, and the ACS obtained a temporary restraining order against the group that prevented the spot from being aired.

(h/t Ben Smith, who diligently reported on the back and forth as it unfurled.)

Watching You

And that’s not the only ad from Rethink Reform in this edition of Extras. The group also has been airing an ad mimicking the Geico commercials that feature the classic Rockwell song "Somebody’s Watching Me" and a pile of money topped with a pair of googly eyes. In Rethinking Reform’s ad, it is the 2,000-page health care bill that is humanized with the googly eyes.

The spoof says that under "the new government plan, you don’t buy your insurance until after you get sick. … It’s a scam. Now you wait until you’re sick, then get the coverage.”

Technically, that’s not how the health care bills would work, but the ad points to a legitimate debate on the enforcement mechanism of the individual mandate. Is it strong enough to force people to get health coverage?

Both the House and the Senate bills include an individual mandate, requiring people to have health insurance, and imposing monetary penalties if they refuse to get it. The bills also say that insurance companies can’t deny coverage because of preexisting conditions. So someone could disobey the mandate, pay a penalty and wait to get insurance once they have some type of medical condition. That person would have to pay 2.5 percent of adjusted gross income (up to the cost of a qualified health plan) under the House bill, and would be fined $750 a year, up to $2,250 per family under the Senate bill. Not to mention that anyone who tried this would have to pay out of pocket for any health care costs incurred before he or she actually got insurance. There’s no such thing as retroactive health coverage.

Some, such as the insurance industry lobby, have argued that the Senate bill’s penalties are not strict enough to prompt people to get coverage. M.I.T. economist Jonathan Gruber believes the fine should be higher, but he predicts the mandate will still cause many to sign up for health care. "We don’t know what the magic number needs to be for the penalty to be effective," he told BusinessWeek magazine. "But the fact is, most of us are law-abiding. No one riots over buying car insurance, it’s just a fact of life. This could turn out to be the same."

The Congressional Budget Office, too, estimated that 94 percent of the population, excluding illegal immigrants, would have health insurance by 2016 under the bill – that’s up from 83 percent now. (The House bill would cover 96 percent by 2015.) Another projection came from the chief actuary of the Centers for Medicare and Medicaid Services, who estimated that 24 million citizens would remain uninsured by 2019 under the Senate bill. Of those, the report said, 19 million would skip health coverage and pay the penalty. Most would find the penalty to be cheaper than health insurance; others would act against their own best interests.

CMS memo, Dec. 10: For the most part, these would be individuals with relatively low health care expenses for whom the individual or family insurance premium would be significantly in excess of any penalty and their anticipated health benefit value. In other instances, as appears to happen under current law, some people would not enroll in their employer plans (or take advantage of the Exchange opportunities) even though it would be in their best financial interest to do so.

Father’s Keeper?

The Susan B. Anthony List and CatholicVoteAction.org released an ad attacking Democratic Sen. Bob Casey Jr. of Pennsylvania for supporting the Senate health care bill. The ad juxtaposes the bill against the words of Casey’s late father, former Pennsylvania Gov. Bob Casey Sr., speaking against abortion.

Robert Casey Sr., Notre Dame, 1995: [Abortion] is inconsistent with our national character, with our national purpose, with all that we’ve done, and with everything we hope to be.

The fight over abortion language in the bill is still playing out, but we have seen no evidence supporting the ad’s assertion that "the bill will result in more abortions." At best, this is speculation. According to Joy Yearout, a spokeswoman for the Susan B. Anthony List: "It is our argument that when federal funding restrictions are loosened through policy established in the Senate bill, that abortion rates will see a corresponding increase." But the bill retains prohibitions on federal funding of abortion except in cases of rape, incest or life endangerment; public subsidies paid to insurance plans in the new exchanges are supposed to be kept separate from privately paid premiums that could be used to buy abortion coverage. Yearout’s group and other abortion foes believe the firewall isn’t thick enough.

Casey has come up with a possible compromise on the issue. And another Catholic group, the Catholic Health Association, yesterday issued a press release praising the senator for his efforts, saying the group was "increasingly confident that Senator Casey’s language can achieve the objective of no federal funding for abortion." No word yet whether Casey’s compromise proposal will pass muster with enough senators on both sides of the issue.